Pregnant Women with Schizophrenia

One FDA-Approved Drug, One Off-Label Drug, and One Non-Pharmacological Intervention

Schizophrenia is a mental disorder that affects the way an individual interprets reality. It can be characterized by hallucinations, disordered thinking, and delusions, which impair an individual’s daily functioning. Schizophrenia can be increasingly disabling for pregnant women. The disease is associated with poor obstetrical outcomes such as low birth weight and the risk of congenital malformations. Abilify (aripiprazole) is one of the FDA-approved medications for schizophrenia. The FDA approved the medication for the treatment of bipolar disorder and schizophrenia in 2002. Abilify is an antipsychotic drug used to ease schizophrenia symptoms such as hallucinations (Cuomo et al., 2018). Secondly, quetiapine (Seroquel) is an atypical antipsychotic treatment used to treat illnesses such as bipolar disorder and schizophrenia. Quetiapine is an off-drug medication that pregnant women can take. The decision to prescribe quetiapine often varies from one patient to another. For instance, quetiapine can be the best option for one patient but not appropriate for another. The drug can be used with antidepressant medications and comes in tablet form.

Finally, pregnant women with schizophrenia have access to a wide variety of non-pharmacological interventions. Electroconvulsive therapy (ECT) is one of the safest non-pharmacological treatments for schizophrenia. Also identified as electroshock, ECT is a procedure where electric currents are passed through the patient’s brain while under general anesthesia. The main aim of the procedure is meant to trigger a brief seizure that changes the brain’s chemistry, which can reverse the symptoms of schizophrenia. ECT is often required when other treatments are ineffective. It is considered the safest treatment option among pregnant women due to reduced adverse effects.

Risk Assessment

Risk assessment when prescribing Abilify for pregnant women with schizophrenia is critical. Several conditions are contraindicated with Abilify. The physician must identify whether the patient is diabetic or prediabetic since aripiprazole is associated with the possibility of spiking the blood sugar levels of an individual. In effect, it can make it difficult to control diabetes (Uguz & Orsolini, 2019). Secondly, it is important to consider the patient’s age. Studies identify that young adults have a higher probability of experiencing suicidal thoughts when taking Abilify. It is also essential to determine if the patient has any allergies. The information can help identify whether the patient is allergic to the drug, which can cause serious problems. The patient’s work history or level of physical activity is important to assess because the medication can make an individual sweat less ad increase the risk of a heat stroke.

Physicians should conduct a risk assessment when prescribing quetiapine to pregnant patients with schizophrenia. It is important to assess the patient’s diabetic history since the drug can raise blood sugar levels (Uguz & Orsolini, 2019). The patient’s blood pressure levels should also be assessed. Notably, Seroquel can result in a drop in the patient’s blood pressure when moving. Additionally, Seroquel can cause weight gain. In effect, the patient’s weight should be monitored throughout the treatment. Finally, the physician must consider the patient’s history with addiction. Quetiapine is one of the most common antipsychotic drugs associated with addiction. Thus, the physician must assess several risk factors that must be considered while prescribing Seroquel.

Clinical Practice Guidelines

The American Psychiatric Association provided a practice guideline for the treatment of and care for patients with schizophrenia. The APA Practice Guideline was approved by the Board of Trustees in 2019. It was developed based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The guideline is divided into different sections. The first section focuses on assessing and determining the treatment plan (American Psychiatric Association, 2021). In this section, it is essential to focus on areas such as the initial assessment process, the initial psychiatric evaluation process, and the significance and ways of documenting a treatment plan for patients using evidence-based non-pharmacological and pharmacological treatment plans.

Furthermore, the practice guideline uncovers significant issues concerning pharmacotherapy and psychosocial intervention. The guideline emphasizes the need to monitor patients after providing them with antipsychotic medication. It also provides healthcare practitioners with medication information in cases where the psychotic drugs work and in cases where they are ineffective. A significant section identifies the need for incorporating long-acting injectable psychotic medications and their potential effectiveness. The pharmacotherapy section also identifies the options for patients suffering from different diseases such as acute dystonia, Parkinson’s disease, and akathisia (American Psychiatric Association, 2021). In the psychosocial intervention section, the guideline identifies the different interventions to consider. For instance, patients that experience their initial psychosis episode should be placed in a coordinated specialty care program. It also recommends that cognitive-behavioral therapy is essential for patients who have schizophrenia. If a patient has poor engagement with related services, they need to receive assertive community treatment to reduce relapses. Family interventions can also prove effective for patients who constantly engage with family members. Other psychosocial interventions that need to be considered include supportive psychotherapy and cognitive mediation.

References

American Psychiatric Association. (2021). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association.

Cuomo, A., Goracci, A., & Fagiolini, A. (2018). Aripiprazole uses during pregnancy, peripartum, and lactation. A systematic literature search and review to inform clinical practice. Journal of Affective Disorders, 228, 229-237. https://doi.org/10.1016/j.jad.2017.12.021

Uguz, F., & Orsolini, L. (2019). Perinatal Psychopharmacology. Springer.

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